Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, PO Box 90203, 1006 BE Amsterdam, The Netherlands.
Breast Cancer Res Treat. 2012 Jan;131(1):117-26. doi: 10.1007/s10549-011-1767-9. Epub 2011 Sep 21.
The aim of the present study was to investigate if 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) outperforms conventional imaging techniques for excluding distant metastases prior to neoadjuvant chemotherapy (NAC) treatment in patients with stage II and III breast cancer. Second, we assessed the clinical importance of false positive findings. One hundred and fifty four patients with stage II or III breast cancer, scheduled to receive NAC, underwent an 18F-FDG PET/CT scan and conventional imaging, consisting of bone scintigraphy, ultrasound of the liver, and chest radiography. Suspect additional lesions at staging examination were confirmed by biopsy and histopathology and/or additional imaging. Metastases that were detected within 6 months after the PET/CT scan were considered evidence of occult metastasis, missed by staging examination. Forty-two additional distant lesions were seen in 25 patients with PET/CT and could be confirmed in 20 (13%) of 154 patients. PET/CT was false positive for 8 additional lesions (19%) and misclassified the presence of metastatic disease in 5 (3%) of 154 patients. In 16 (80%) of 20 patients, additional lesions were exclusively seen with PET/CT, leading to a change in treatment in 13 (8%) of 154 patients. In 129 patients with a negative staging PET/CT, no metastases developed during the follow-up of 9.0 months. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT in the detection of additional distant lesions in patients with stage II or III breast cancer are 100, 96, 80, 100, and 97%, respectively. FDG PET/CT is superior to conventional imaging techniques in the detection of distant metastases in patients with untreated stage II or III breast cancer and is associated with a low false positive rate. PET/CT may be of additional value in the staging of breast cancer prior to NAC.
本研究旨在探讨 18F-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）是否优于常规影像学技术，用于排除接受新辅助化疗（NAC）治疗的 II 期和 III 期乳腺癌患者的远处转移。其次，我们评估了假阳性结果的临床重要性。154 例 II 期或 III 期乳腺癌患者，计划接受 NAC，行 18F-FDG PET/CT 扫描和常规影像学检查，包括骨闪烁扫描、肝脏超声和胸部 X 线摄影。分期检查中怀疑有额外的病变通过活检和组织病理学和/或额外的影像学检查进行确认。PET/CT 扫描后 6 个月内发现的转移灶被认为是分期检查漏诊的隐匿性转移灶。在 25 例 PET/CT 检查中发现 42 例额外的远处病变，在 154 例患者中可确认 20 例（13%）。PET/CT 假阳性 8 例（19%），假阳性 5 例（3%），误诊为转移性疾病。在 20 例患者中，仅在 PET/CT 上发现了额外的病变，导致 154 例患者中的 13 例（8%）改变了治疗方案。在 129 例分期 PET/CT 阴性的患者中，在 9.0 个月的随访期间未发现转移。PET/CT 在检测 II 期或 III 期乳腺癌患者的额外远处病变中的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为 100%、96%、80%、100%和 97%。FDG PET/CT 在检测未经治疗的 II 期或 III 期乳腺癌患者的远处转移方面优于常规影像学技术，且假阳性率较低。PET/CT 在 NAC 前对乳腺癌进行分期可能具有额外的价值。
